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1.
Medicine (Baltimore) ; 100(6): e23859, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578513

RESUMO

BACKGROUND: We aimed to examine the feasibility of our newly-developed, integrated, and high-intensity individual cognitive behavioral therapy (CBT) protocol for treatment-resistant chronic pain. METHODS: We conducted an open-labeled prospective single-arm trial for patients aged 18 years and above, suffering from chronic pain, and diagnosed with somatic symptom disorder with predominant pain. We provided 16 weekly sessions of CBT, each lasting for 50 minutes, which included 4 new strategies: attention shift, memory work, mental practice, and video feedback. For comparison, the study had a pre-test post-test design. The primary outcome was the change from baseline (week 1) to 16, as indicated by the Numerical Rating Scale and Pain Catastrophizing Scale. In addition, we evaluated depression, anxiety, disability, and quality of life as secondary outcomes. RESULTS: Sixteen patients with chronic pain underwent our CBT program. Though there was no reduction in pain intensity, catastrophic cognition showed statistically significant improvement with a large effect size. Depression, anxiety, and disability demonstrated statistically significant improvements, with small to moderate effect sizes. No adverse events were reported. CONCLUSION: Our newly integrated CBT program for chronic pain may improve catastrophic cognition, depression, anxiety, and disability. Large-scale randomized controlled studies are necessary to investigate the program's effectiveness in the future.


Assuntos
Dor Crônica/terapia , Terapia Cognitivo-Comportamental/métodos , Manejo da Dor/métodos , Adulto , Idoso , Ansiedade/etiologia , Ansiedade/terapia , Dor Crônica/complicações , Dor Crônica/psicologia , Terapia Cognitivo-Comportamental/estatística & dados numéricos , Depressão/etiologia , Depressão/terapia , Avaliação da Deficiência , Estudos de Viabilidade , Feminino , Humanos , Japão/epidemiologia , Masculino , Sintomas Inexplicáveis , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento
2.
Rev. Hosp. Ital. B. Aires (2004) ; 40(4): 191-198, dic. 2020. tab
Artigo em Espanhol | LILACS | ID: biblio-1145493

RESUMO

Introducción: el siguiente estudio tuvo como finalidad explorar algunas características demográficas asociadas al dolor crónico y el desarrollo de ideas de suicidio en una población de pacientes mayores de 65 años. Método: se realizó un estudio observacional y analítico de corte transversal mediante el relevamiento de datos a partir historias clínicas de pacientes mayores de 65 años que concurrieron a los consultorios externos del equipo de geriatría del Servicio de Psiquiatría del Hospital Italiano de Buenos Aires, entre junio de 2018 y diciembre de 2018. Resultados: se incluyó en el estudio un total de 222 pacientes, de los cuales 50 (23%) presentaron indicadores de dolor crónico y 33 pacientes (14,6%) lo hicieron de ideación suicida. Mediante estudio de correlación se estableció que estar ocupado, padecer dolor crónico y haber tenido más de una internación psiquiátrica son factores que incrementan el riesgo de presentar ideación suicida. Las variables ideación suicida, edad, y el estado civil ‒separado o divorciado en comparación con estar casado‒ son factores asociados a la presencia de dolor crónico. Conclusiones: el dolor crónico y la ideación suicida son factores que contribuyen a aumentar la fragilidad en personas mayores y deben ser estudiados en mayor profundidad para comprender los distintos modos de expresión de la patología psiquiátrica en esta población. (AU)


Introduction: the following study aimed to explore some demographic characteristics associated with chronic pain and the development of suicidal ideas in a population of patients over 65 years. Method: an cross-sectional observational and analytical study was carried out by collecting data from clinical histories of patients over 65 years of age who attended the external offices of the geriatrics team of the Psychiatry service of the Italian Hospital of Buenos Aires between June 2018 and December 2018. Results: a total of 222 patients were included in the study, of which 50 (23%) presented indicators of chronic pain and 33 patients (14.6%) had suicidal ideation. A correlation study established that being employed, suffering from chronic pain and having had more than one psychiatric hospitalization are factors that increase the risk of presenting suicidal ideation. The variables suicidal ideation, age, and separated or divorced marital status compared to being married are factors associated with the presence of chronic pain. Conclusions: chronic pain and suicidal ideation are factors that contribute to increasing frailty in elderly patients and should be studied in greater depth to understand the different modes of expression of psychiatric pathology in this population. (AU)


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Ideação Suicida , Dor Crônica/epidemiologia , Argentina/epidemiologia , Psicotrópicos/uso terapêutico , Suicídio/psicologia , Suicídio/estatística & dados numéricos , Pesar , Estudos Transversais , Fatores de Risco , Fatores Etários , Estado Civil/estatística & dados numéricos , Demência/psicologia , Dor Crônica/psicologia , Disfunção Cognitiva/psicologia , Fragilidade/psicologia , Psiquiatria Geriátrica/estatística & dados numéricos
4.
Transl Behav Med ; 10(4): 827-834, 2020 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-32885815

RESUMO

The COVID-19 pandemic has slowed research progress, with particularly disruptive effects on investigations of addressing urgent public health challenges, such as chronic pain. The National Institutes of Health (NIH) Department of Defense (DoD) Department of Veterans Affairs (VA) Pain Management Collaboratory (PMC) supports 11 large-scale, multisite, embedded pragmatic clinical trials (PCTs) in military and veteran health systems. The PMC rapidly developed and enacted a plan to address key issues in response to the COVID-19 pandemic. The PMC tracked and collaborated in developing plans for addressing COVID-19 impacts across multiple domains and characterized the impact of COVID-19 on PCT operations, including delays in recruitment and revisions of study protocols. A harmonized participant questionnaire will facilitate later meta-analyses and cross-study comparisons of the impact of COVID-19 across all 11 PCTs. The pandemic has affected intervention delivery, outcomes, regulatory and ethics issues, participant recruitment, and study design. The PMC took concrete steps to ensure scientific rigor while encouraging flexibility in the PCTs, while paying close attention to minimizing the burden on research participants, investigators, and clinical care teams. Sudden changes in the delivery of pain management interventions will probably alter treatment effects measured via PMC PCTs. Through the use of harmonized instruments and surveys, we are capturing these changes and plan to monitor the impact on research practices, as well as on health outcomes. Analyses of patient-reported measures over time will inform potential relationships between chronic pain, mental health, and various socioeconomic stressors common among Americans during the COVID-19 pandemic.


Assuntos
Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus , Saúde Mental/tendências , Manejo da Dor , Pandemias , Pneumonia Viral , Pesquisa , Betacoronavirus , Dor Crônica/epidemiologia , Dor Crônica/psicologia , Dor Crônica/terapia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Humanos , National Institutes of Health (U.S.) , Manejo da Dor/ética , Manejo da Dor/métodos , Manejo da Dor/tendências , Pandemias/prevenção & controle , Seleção de Pacientes , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pesquisa/organização & administração , Pesquisa/tendências , Fatores Socioeconômicos , Estados Unidos/epidemiologia , United States Department of Veterans Affairs
6.
Gerokomos (Madr., Ed. impr.) ; 31(3): 144-148, sept. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-197349

RESUMO

La prevalencia de dolor en personas mayores de 65 años oscila entre el 30-50% en la comunidad hasta el 70% en institucionalizados. El dolor debe considerarse como un síndrome geriátrico. Para la evaluación apropiada del dolor se deben usar herramientas validadas.La demencia en sí misma no es dolorosa; se estima que el 30-50% de mayores que tienen demencia experimentan dolor crónico. Este dolor puede contribuir a aumentar los síntomas conductuales y psicológicos de la demencia.Los objetivos de esta revisión fueron examinar las escalas observacionales para el dolor validadas en español e identificar cuáles son las intervenciones no farmacológicas para tratar el dolor en personas con demencia moderada-severa.La evaluación del dolor en personas con demencia moderada o avanzada ha de ser multicontextual; siempre se aconseja preguntar directamente a la persona si refiere dolor. Las cuatro herramientas recomendadas en esta revisión son: DOLOPLUS2, PACSLAC, PAINAD y Abbey Pain Scale; estas dos últimas son las más sencillas y rápidas. La implementación de medidas no farmacológicas durante el tratamiento del dolor es positiva, por la disminución del dolor y porque también evita la polimedicación innecesaria, pero aún hay que vencer los prejuicios del personal sanitario y los problemas logísticos de su aplicación.Por último, lo más importante de esta revisión es la propuesta de intervenciones no farmacológicas concretas para tratar el dolor en personas con demencia moderada-severa y que pueden ser prescritas y llevadas a cabo por enfermería


The prevalence of pain in people over 65 years of age oscillates between 30 and 50% within the community, and reaches 70% in institutionalized patients. Pain must be considered a geriatric syndrome. In order to appropriately evaluate pain, validated must be used.Dementia in itself is not painful; it is estimated that 30-50% of older people with dementia have chronic pain. This pain may contribute to an increase in the behavioral and psychological symptoms of dementia.The aims of this revision were to examine the observational scales in pain, validated in Spanish, and identify the non-pharmacological interventions to treat pain in people with moderate to severe dementia.Evaluating pain in people with moderate to severe has to be multidimensional. It is always advised to question pain directly regarding the experience of pain. The four recommended tools in this revision are: DOLOPLUS2, PACSLAC, PAINAD and Abbey Pain Scale; the last two being simpler and quicker. The implementation of non-pharmacological measures during treatment is positive, because of pain reduction and the avoidance of unnecessary medication. However, prejudices from health professionals and organizational problems in applying these, must be overcome.The proposal of concrete non-pharmacological interventions in the treatment of pain is the most important contribution of this review, as they may be prescribed and implemented by nursing staff


Assuntos
Humanos , Manejo da Dor , Demência/epidemiologia , Dor Crônica/epidemiologia , Dor/psicologia , Demência/psicologia , Dor Crônica/psicologia , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/psicologia
7.
Health Qual Life Outcomes ; 18(1): 260, 2020 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-32746838

RESUMO

BACKGROUND: Psychological flexibility is considered a fundamental aspect of health. It includes six interrelated facets: 1) cognitive defusion, 2) acceptance, 3) contact with the present moment, 4) self-as-context, 5) values, and 6) committed action. To gain further insight into psychological flexibility and its effects on health, reliable and valid instruments to assess all facets are needed. Committed action is one facet that is understudied. A long and short version of a validated measure (CAQ and CAQ-8) have been developed in English. Currently, there are no German versions of the CAQ. Aim of this study is to validate German-language versions of these in a chronic pain population. METHODS: The CAQ instructions and items were translated and evaluated in a chronic pain population (N = 181). Confirmatory factor analysis and Mokken scale analysis were conducted to evaluate the German questionnaires. Correlations with health outcomes, including quality of life (SF-12), physical and emotional functioning (MPI, BPI, PHQ-9, GAD-7), pain intensity, and with other facets of psychological flexibility (CPAQ, FAH-II) were investigated for convergent validity purposes. Scale reliability was assessed by the alpha, MS, lambda-2, LCRC, and omega coefficient. RESULTS: A bifactor model consisting of one general factor and two methodological factors emerged from the analysis. Criteria for reliability and validity were met. Medium to strong correlations to health outcomes and other facets of psychological flexibility were found. Results were similar to the original English version. CONCLUSIONS: The present study presents a valid and reliable instrument to investigate committed action in German populations. Future studies could expand the present findings by evaluating the German CAQ versions in non-pain populations. The role of committed action and the wider psychological flexibility model in pain and other conditions deserves further investigation.


Assuntos
Adaptação Psicológica , Dor Crônica/psicologia , Qualidade de Vida , Inquéritos e Questionários/normas , Adulto , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Traduções
8.
J Orthop Sports Phys Ther ; 50(8): 418-430, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32736497

RESUMO

OBJECTIVE: To find out which interventions enhance pain self-efficacy in people with chronic musculoskeletal pain and to evaluate the reporting of interventions designed to enhance pain self-efficacy. DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: PubMed, Embase, Scopus, PsycINFO, CINAHL, PEDro, and the Cochrane Central Register of Controlled Trials were searched from inception up to September 2019. STUDY SELECTION CRITERIA: Randomized controlled trials evaluating pain self-efficacy as a primary or secondary outcome in chronic musculoskeletal pain. DATA SYNTHESIS: We used the Cochrane risk of bias tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to evaluate the risk of bias and the certainty of the evidence, respectively. RESULTS: Sixty randomized controlled trials were included (12 415 participants). There was a small effect of multicomponent, psychological, and exercise interventions improving pain self-efficacy at follow-ups of 0 to 3 months, a small effect of exercise and multicomponent interventions enhancing pain self-efficacy at follow-ups of 4 to 6 months, and a small effect of multicomponent interventions improving pain self-efficacy at follow-ups of 7 to 12 months. No interventions improved pain self-efficacy after 12 months. Self-management interventions did not improve pain self-efficacy at any follow-up time. Risk of bias, the nature of the control group, and the instrument to assess pain self-efficacy moderated the effects of psychological therapies at follow-ups of 7 to 12 months. The certainty of the evidence for all included interventions was low, due to serious risk of bias and indirectness. No trial reported the intervention in sufficient detail to allow full replication. CONCLUSION: There was low-quality evidence of a small effect of multicomponent exercise and psychological interventions improving pain self-efficacy in people with chronic musculoskeletal pain. J Orthop Sports Phys Ther 2020;50(8):418-430. doi:10.2519/jospt.2020.9319.


Assuntos
Dor Crônica/psicologia , Dor Crônica/terapia , Dor Musculoesquelética/psicologia , Dor Musculoesquelética/terapia , Autoeficácia , Terapia Cognitivo-Comportamental , Terapia por Exercício , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Autogestão
9.
Cochrane Database Syst Rev ; 8: CD007407, 2020 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-32794606

RESUMO

BACKGROUND: Chronic non-cancer pain, a disabling and distressing condition, is common in adults. It is a global public health problem and economic burden on health and social care systems and on people with chronic pain. Psychological treatments aim to reduce pain, disability and distress. This review updates and extends its previous version, published in 2012. OBJECTIVES: To determine the clinical efficacy and safety of psychological interventions for chronic pain in adults (age > 18 years) compared with active controls, or waiting list/treatment as usual (TAU). SEARCH METHODS: We identified randomised controlled trials (RCTs) of psychological therapies by searching CENTRAL, MEDLINE, Embase and PsycINFO to 16 April 2020. We also examined reference lists and trial registries, and searched for studies citing retrieved trials. SELECTION CRITERIA: RCTs of psychological treatments compared with active control or TAU of face-to-face therapies for adults with chronic pain. We excluded studies of headache or malignant disease, and those with fewer than 20 participants in any arm at treatment end. DATA COLLECTION AND ANALYSIS: Two or more authors rated risk of bias, extracted data, and judged quality of evidence (GRADE). We compared cognitive behavioural therapy (CBT), behavioural therapy (BT), and acceptance and commitment therapy (ACT) with active control or TAU at treatment end, and at six month to 12 month follow-up. We did not analyse the few trials of other psychological treatments. We assessed treatment effectiveness for pain intensity, disability, and distress. We extracted data on adverse events (AEs) associated with treatment. MAIN RESULTS: We added 41 studies (6255 participants) to 34 of the previous review's 42 studies, and now have 75 studies in total (9401 participants at treatment end). Most participants had fibromyalgia, chronic low back pain, rheumatoid arthritis, or mixed chronic pain. Most risk of bias domains were at high or unclear risk of bias, with selective reporting and treatment expectations mostly at unclear risk of bias. AEs were inadequately recorded and/or reported across studies. CBT The largest evidence base was for CBT (59 studies). CBT versus active control showed very small benefit at treatment end for pain (standardised mean difference (SMD) -0.09, 95% confidence interval (CI) -0.17 to -0.01; 3235 participants; 23 studies; moderate-quality evidence), disability (SMD -0.12, 95% CI -0.20 to -0.04; 2543 participants; 19 studies; moderate-quality evidence), and distress (SMD -0.09, 95% CI -0.18 to -0.00; 3297 participants; 24 studies; moderate-quality evidence). We found small benefits for CBT over TAU at treatment end for pain (SMD -0.22, 95% CI -0.33 to -0.10; 2572 participants; 29 studies; moderate-quality evidence), disability (SMD -0.32, 95% CI -0.45 to -0.19; 2524 participants; 28 studies; low-quality evidence), and distress (SMD -0.34, 95% CI -0.44 to -0.24; 2559 participants; 27 studies; moderate-quality evidence). Effects were largely maintained at follow-up for CBT versus TAU, but not for CBT versus active control. Evidence quality for CBT outcomes ranged from moderate to low. We rated evidence for AEs as very low quality for both comparisons. BT We analysed eight studies (647 participants). We found no evidence of difference between BT and active control at treatment end (pain SMD -0.67, 95% CI -2.54 to 1.20, very low-quality evidence; disability SMD -0.65, 95% CI -1.85 to 0.54, very low-quality evidence; or distress SMD -0.73, 95% CI -1.47 to 0.01, very low-quality evidence). At follow-up, effects were similar. We found no evidence of difference between BT and TAU (pain SMD -0.08, 95% CI -0.33 to 0.17, low-quality evidence; disability SMD -0.02, 95% CI -0.24 to 0.19, moderate-quality evidence; distress SMD 0.22, 95% CI -0.10 to 0.54, low-quality evidence) at treatment end. At follow-up, we found one to three studies with no evidence of difference between BT and TAU. We rated evidence for all BT versus active control outcomes as very low quality; for BT versus TAU. Evidence quality ranged from moderate to very low. We rated evidence for AEs as very low quality for BT versus active control. No studies of BT versus TAU reported AEs. ACT We analysed five studies (443 participants). There was no evidence of difference between ACT and active control for pain (SMD -0.54, 95% CI -1.20 to 0.11, very low-quality evidence), disability (SMD -1.51, 95% CI -3.05 to 0.03, very low-quality evidence) or distress (SMD -0.61, 95% CI -1.30 to 0.07, very low-quality evidence) at treatment end. At follow-up, there was no evidence of effect for pain or distress (both very low-quality evidence), but two studies showed a large benefit for reducing disability (SMD -2.56, 95% CI -4.22 to -0.89, very low-quality evidence). Two studies compared ACT to TAU at treatment end. Results should be interpreted with caution. We found large benefits of ACT for pain (SMD -0.83, 95% CI -1.57 to -0.09, very low-quality evidence), but none for disability (SMD -1.39, 95% CI -3.20 to 0.41, very low-quality evidence), or distress (SMD -1.16, 95% CI -2.51 to 0.20, very low-quality evidence). Lack of data precluded analysis at follow-up. We rated evidence quality for AEs to be very low. We encourage caution when interpreting very low-quality evidence because the estimates are uncertain and could be easily overturned. AUTHORS' CONCLUSIONS: We found sufficient evidence across a large evidence base (59 studies, over 5000 participants) that CBT has small or very small beneficial effects for reducing pain, disability, and distress in chronic pain, but we found insufficient evidence to assess AEs. Quality of evidence for CBT was mostly moderate, except for disability, which we rated as low quality. Further trials may provide more precise estimates of treatment effects, but to inform improvements, research should explore sources of variation in treatment effects. Evidence from trials of BT and ACT was of moderate to very low quality, so we are very uncertain about benefits or lack of benefits of these treatments for adults with chronic pain; other treatments were not analysed. These conclusions are similar to our 2012 review, apart from the separate analysis of ACT.


Assuntos
Dor Crônica/terapia , Terapia Cognitivo-Comportamental/métodos , Terapia de Aceitação e Compromisso , Adulto , Afeto , Terapia Comportamental/métodos , Viés , Dor Crônica/psicologia , Intervalos de Confiança , Humanos , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
10.
PLoS One ; 15(8): e0236111, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790685

RESUMO

A relationship between chronic pain and frailty has been reported. The early detection and prevention of frailty are recommended, in part because community-dwelling older adults in a pre-frailty state may return to a healthy state. The relationship between chronic pain and pre-frailty is not known. Toward the goal of promoting a reversible return to health from pre-frailty, we investigated the relationship between chronic pain and pre-frailty among community-dwelling older adults. We assessed the frailty and chronic pain of 107 older adults who were participating in community health checks. The status of physical frailty was based on the five components described by Fried (2001): muscle weakness shown by handgrip strength, slowness of gait speed, weight loss, low physical activity, and exhaustion. Chronic pain was assessed based on pain intensity, the Pain Catastrophizing Scale (PCS), the Japanese version of the Geriatric Depression Scale-15 (GDS-15), and the Central Sensitization Inventory (CSI). The prevalence of chronic pain with pre-frailty was 40.2%. A hierarchical analysis revealed that PCS-measured helplessness (odds ratio [OR]: 0.88) and the CSI (OR: 0.87) were significant factors associated with the presence of chronic pain with pre-frailty. The prevalence of chronic pain with pre-frailty was high, and chronic pain and pre-frailty were strongly related. New intervention or prevention programs that take into account both chronic pain and pre-frailty must be created as soon as possible.


Assuntos
Catastrofização/epidemiologia , Dor Crônica/epidemiologia , Fragilidade/prevenção & controle , Vida Independente , Debilidade Muscular/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Catastrofização/psicologia , Dor Crônica/complicações , Dor Crônica/diagnóstico , Dor Crônica/psicologia , Estudos Transversais , Feminino , Idoso Fragilizado/psicologia , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/diagnóstico , Fragilidade/etiologia , Avaliação Geriátrica , Força da Mão , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/diagnóstico , Debilidade Muscular/etiologia , Medição da Dor , Prevalência
11.
Pain Res Manag ; 2020: 3408052, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32714478

RESUMO

Objective: To provide a brief and comprehensive summary of the recent evidence from clinical trials testing psychotherapeutic interventions in patients with fibromyalgia with particular interest in their possible effect on physical pain. Methods: Bibliographical search was performed in PubMed, PsycInfo, Web of Science, Scopus, and Cochrane Library databases. Content of the manuscripts was studied to obtain, if available, the following information: year of publication, location of the research team, design, type of psychotherapeutic intervention tested, pain measures, and a brief description of the psychotherapy, groups, and outcomes regarding physical pain. Results: Initial search eliciting 475 citations got reduced to 13 relevant papers. Most research studies from Spain (n = 8) are randomized control trials (n = 10) and used guided imagery (n = 5) or cognitive behavioral therapy (n = 4). The Visual Analogue Scale (n = 4) and the Fibromyalgia Impact Questionnaire (n = 4) were the physical pain measures mostly used. Improvements on physical pain were reported on all studies with published results; nevertheless, only in five cases, differences were significant. Conclusions: Evidence on the effect of psychotherapy on physical pain in patients with FS was divergent; though most studies report a reduction in pain, this was not always lasting and/or significant. Diversity of the results might be due to the selected psychotherapeutic approaches, assessment tools, and other internal (e.g., personality traits, (sub)clinical psychiatric symptoms, and treatment adherence) and external (e.g., family environment and social support) variables worth to be considered in the future research.


Assuntos
Fibromialgia/psicologia , Fibromialgia/terapia , Psicoterapia/métodos , Dor Crônica/etiologia , Dor Crônica/psicologia , Dor Crônica/terapia , Humanos , Espanha
12.
PLoS One ; 15(7): e0236734, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32716976

RESUMO

OBJECTIVES: Health and wellness coaching (HWC) interventions have been reported to improve health outcomes for individuals with chronic diseases such as diabetes, cardiovascular disease, or cancer. However, HWC also holds potential as an effective intervention within a biopsychosocial chronic pain management framework. The aim of the present study was to evaluate the effects of HWC on individuals with chronic pain. METHODS: Participants were referred by their primary care provider or insurance company to a comprehensive telephonic 12-month pain management HWC program. Relationships between pain outcomes and physical and psychological factors were retrospectively analyzed. Mixed linear-effects modeling explored whether physical and psychological variables were associated with pain outcomes over time. RESULTS: Four hundred nineteen participants (female, 58.9%; mean age, 54.8) enrolled in the program and 181 completed the intervention. After 12 months in the program, statistically and clinically significant reductions were observed for pain intensity (Hedges' g = 1.00) and pain-related interference (Hedges' g = 1.13). Linear mixed-effects modeling indicated that improvements in physical functioning and psychological factors were associated with improvements in pain intensity. DISCUSSION: Our results provide a novel analysis on the effects of HWC on chronic pain and pain-related interference. HWC appears to be a promising intervention to improve pain-related outcomes in a population with chronic pain. Further investigation of HWC as an intervention for chronic pain is warranted.


Assuntos
Dor Crônica/terapia , Pessoal de Saúde/estatística & dados numéricos , Promoção da Saúde , Tutoria/métodos , Manejo da Dor/métodos , Aceitação pelo Paciente de Cuidados de Saúde , Qualidade de Vida , Dor Crônica/fisiopatologia , Dor Crônica/psicologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados não Aleatórios como Assunto , Prognóstico , Estudos Retrospectivos , Inquéritos e Questionários
14.
Pain Res Manag ; 2020: 1765456, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32655723

RESUMO

Purpose: Pacing, avoidance, and overdoing are considered the three main behavioral strategies, also labeled activity patterns. Their relationship with functioning of patients with chronic pain is debated. The purpose of this study was to measure the influence of activity patterns on lifting tasks commonly used in daily life. Method: We performed a monocentric observational study and included patients performing Functional Capacity Evaluation (FCE). Avoidance, pacing, and persistence were assessed with using the Patterns of Activity Measures-Pain (POAM-P). Maximal safe performance was measured for floor-to-waist, waist-to-overhead, horizontal lift, and carrying with dominant-hand tests according to the FCE guidelines. Descriptive statistics, associations of POAM-P subscales with various sociodemographic variables, and correlations are presented. Standard multiple linear regression models were applied to measure the associations between FCE tests and POAM-P subscales, adjusting for the following potential confounders: age, gender, body mass index (BMI), pain severity, trauma severity, localization of injury, and education. Results: Persistence was significantly positively associated with performance on the 4 FCE tests: floor-to-waist (coefficient = 0.20; p=0.001), waist-to-overhead (coefficient = 0.13; p=0.004), horizontal lift (coefficient = 0.31; p ≤ 0.001), and dominant-handed lifting (coefficient = 0.19; p=0.001). Pacing was found to have a negative influence on the carrying dominant-hand test (coefficient = -0.14; p=0.034), and avoidance was not found to have an influence on the 4 FCE tests. Conclusion: This study shows that task-persistence pattern is positively associated with physical performance in FCE, whereas pacing can have a negative influence on some tests.


Assuntos
Adaptação Psicológica , Aprendizagem da Esquiva , Dor Crônica , Dor Musculoesquelética , Adulto , Dor Crônica/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/psicologia , Avaliação da Capacidade de Trabalho
15.
Pain Physician ; 23(4): 349-364, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32709170

RESUMO

BACKGROUND: Certain types of cancer pain have remained hard to control even by highly skilled pain experts. Uncontrolled cancer pain can have severe effects on quality of life, physical functioning, and leads to psychological distress. From this perspective, nonpharmacologic modalities of treatment are important. Neuromodulatory techniques, such as transcutaneous electrical nerve stimulation and scrambler therapy (ST), have gained popularity in recent times. ST is a relatively new therapy that has been used for the management of cancer pain resistant to pharmacologic management. Several studies have shown that ST is an effective therapy for this type of pain. OBJECTIVES: The aim of this study was to detect possible gaps in the literature regarding the efficacy of ST for cancer pain and formulate recommendations for research through a systematic review of the literature. STUDY DESIGN: A systematic review of the literature was performed following the recommendations of the PRISMA Statement. METHODS: PubMed and EMBASE were searched for studies that met the inclusion criteria using a predetermined search strategy. Reference list of retrieved studies and Google Scholar were used to verify that no relevant studies had been omitted. Data were extracted from the studies with a data extraction sheet. A qualitative analyses of the extracted data was undertaken. RESULTS: Twenty-seven studies were retrieved. Ten were articles that were categorized as literature reviews, including 7 general literature reviews not following a specific review methodology, 1 editorial, and 2 systematic reviews. Seventeen were original studies, including 2 single-arm trials, 1 randomized controlled trial, 4 pilot trials, 4 case reports, 2 retrospective studies, and 4 prospective studies. By and large, the available literature supports the use of ST as an effective therapy for the management of refractory cancer pain. However, the level of evidence for its application to cancer pain is not particularly strong, and improvement in pain with ST may even be owing to a placebo effect. LIMITATIONS: This study was not a meta-review. Because of the limited number of clinical trials on ST in cancer pain, such a meta-review could not meaningfully be performed. CONCLUSIONS: Methodologically sound, large randomized control trials are needed in this area. However at this stage, ST may be considered a good option for cancer patients suffering from pain that does not respond to pharmacologic treatment. KEY WORDS: Scrambler therapy, cancer, cancer pain, neuropathic pain, Calmare therapy, evidence, noninvasive pain treatment, chronic pain.


Assuntos
Dor do Câncer/terapia , Neoplasias/terapia , Manejo da Dor/métodos , Estresse Psicológico/terapia , Dor do Câncer/diagnóstico , Dor do Câncer/psicologia , Dor Crônica/diagnóstico , Dor Crônica/psicologia , Dor Crônica/terapia , Ensaios Clínicos como Assunto/métodos , Humanos , Neoplasias/psicologia , Neuralgia/diagnóstico , Neuralgia/psicologia , Neuralgia/terapia , Estudos Prospectivos , Qualidade de Vida/psicologia , Estudos Retrospectivos , Estresse Psicológico/diagnóstico , Estresse Psicológico/psicologia , Estimulação Elétrica Nervosa Transcutânea/métodos , Resultado do Tratamento
16.
Pain Physician ; 23(4): E399-E408, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32709186

RESUMO

BACKGROUND: Patients with nonspecific chronic low back pain (NCLBP) have greater difficulty generating kinesthetic and visual motor imagery. OBJECTIVES: The main aim of this study was to determine whether the ability to generate mental motor imagery (MIab) influences psychological, motor, and disability variables in patients with NCLBP. The secondary aim was to determine whether an approach based on therapeutic exercise (TE) and therapeutic education (TEd) could improve the MIab in those patients with less ability to perform it. STUDY DESIGN: Cross-sectional and quasiexperimental study. SETTING: Physical Therapy Unit of primary health care center in Madrid, Spain. METHODS: A total of 68 patients were divided into 2 groups according to a greater (n = 34) or lesser (n = 34) MIab. Treatment was based on TEd and TE for the group with less ability to generate kinesthetic and visual motor imagery. The outcome measures were imagery requested time, self-efficacy, disability, pain intensity, lumbar strength, psychological variables, and MIab. RESULTS: The group with lesser MIab showed lower levels of self-efficacy (P = 0.04; d, -0.47) and lower levels of lumbar strength and extension strength (P = 0.04; d, -0.46 and P = 0.02; d, -0.52, respectively). After the intervention with TE and TEd, MIab (both kinesthetic and visual) improved significantly, with a moderate to large effect size (P <= 0.01; d, -0.80 and P <= 0.01; d, -0.76, respectively), as did pain intensity, lumbar strength, disability, and psychological variables (P < 0.05), but not levels of self-efficacy (P > 0.05). Based on the results, the patients with NCLBP with lesser MIab achieved lower levels of self-efficacy and lower strength levels. LIMITATIONS: The results of this study should be interpreted with caution because of its quasiexperimental design and a bias selection. CONCLUSIONS: A clinical TE approach, coupled with a TEd program, resulted in significant improvement in MIab (both kinesthetic and visual), reduced pain intensity, increased lumbar strength, reduced disability, and improved psychological variables, but it did not significantly improve self-efficacy levels in the patients with NCLBP. KEY WORDS: Chronic low back pain, motor imagery, disability, lumbar strength.


Assuntos
Dor Crônica/psicologia , Dor Crônica/terapia , Imaginação/fisiologia , Dor Lombar/psicologia , Dor Lombar/terapia , Atividade Motora/fisiologia , Adulto , Estudos Transversais , Pessoas com Deficiência , Terapia por Exercício/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autoeficácia
17.
Medicine (Baltimore) ; 99(29): e21230, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702896

RESUMO

The aim of this study is to investigate the relation between parenting style and chronic pain and the patients' need for psychosomatic treatment in adulthood.We compared 4 combinations of 2 parenting style subscales, high and low care and overprotection, among the following 4 age- and sex-matched groups: community-dwelling subjects without chronic pain (n = 100), community-dwelling subjects with chronic pain (n = 100), outpatients with chronic pain (n = 50), and inpatients with chronic pain (n = 50). Parenting style was assessed for both the mother and father by use of the Parental Bonding Instrument questionnaire. The parenting style associated with the worst outcome was defined as both low care and high overprotection, as reported in previous studies.The frequency of reported adverse parenting style was significantly higher among chronic pain patients than community-dwelling subjects without chronic pain (all P < .05). The odds ratios for an adverse parenting style significantly increased through the categories after adjusting for demographic factors and the pain visual analog scale (P for trend <.01).These findings suggest that parental low care and high overprotection during childhood contribute to the future risk of chronic pain and the patients' need for psychosomatic treatment in adulthood.


Assuntos
Dor Crônica/psicologia , Poder Familiar/psicologia , Transtornos Psicofisiológicos/psicologia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Fatores de Risco , Inquéritos e Questionários
18.
NeuroRehabilitation ; 47(1): 35-43, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32675428

RESUMO

BACKGROUND: Chronic musculoskeletal pain is a complex problem, particularly for individuals with head injury and comorbid psychiatric conditions. The Fear Avoidance Model offers one of the strongest opportunities to conceptualize comorbid traumatic injury and pain, but this model is largely untested. OBJECTIVE: This study tests the Fear Avoidance Model of chronic pain using a sample from a study of polytrauma patients in a large Department of Veterans Affairs facility who participated in a federally-funded study of interdisciplinary chronic pain management. METHODS: The present study comprises a secondary analysis of 93 veterans with chronic pain, head injury, posttraumatic stress symptoms and a history of persistent opioid use. Standardized measures of Fear Avoidance Model risk factors (e.g., pain catastrophizing, fear avoidance beliefs, anxiety, depression) were examined as cross-sectional predictors of pain-related disability. RESULTS: Secondary data analysis revealed that Fear Avoidance Model factors accounted for almost 40% of the variance in pain-related disability, with pain catastrophizing and depression demonstrating the strongest relationships with disability. A summary variable combining all four factors revealed a 6% increase in disability for each factor that was clinically significant for the sample patients. CONCLUSIONS: This study represents the first attempt to examine a complex, theoretical model of pain in a comorbid pain and TBI sample. Findings revealed a strong relationship between this model and pain-related disability that outperforms pain intensity ratings. This model could be used to guide better treatment for comorbid pain and TBI.


Assuntos
Catastrofização/psicologia , Dor Crônica/psicologia , Medo/psicologia , Traumatismo Múltiplo/psicologia , Adulto , Catastrofização/diagnóstico , Dor Crônica/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/diagnóstico , Medição da Dor , Prognóstico , Inquéritos e Questionários
19.
BMJ ; 370: m1668, 2020 07 20.
Artigo em Inglês | MEDLINE | ID: mdl-32690477

RESUMO

Despite their ubiquitous presence, placebos and placebo effects retain an ambiguous and unsettling presence in biomedicine. Specifically focused on chronic pain, this review examines the effect of placebo treatment under three distinct frameworks: double blind, deception, and open label honestly prescribed. These specific conditions do not necessarily differentially modify placebo outcomes. Psychological, clinical, and neurological theories of placebo effects are scrutinized. In chronic pain, conscious expectation does not reliably predict placebo effects. A supportive patient-physician relationship may enhance placebo effects. This review highlights "predictive coding" and "bayesian brain" as emerging models derived from computational neurobiology that offer a unified framework to explain the heterogeneous evidence on placebos. These models invert the dogma of the brain as a stimulus driven organ to one in which perception relies heavily on learnt, top down, cortical predictions to infer the source of incoming sensory data. In predictive coding/bayesian brain, both chronic pain (significantly modulated by central sensitization) and its alleviation with placebo treatment are explicated as centrally encoded, mostly non-conscious, bayesian biases. The review then evaluates seven ways in which placebos are used in clinical practice and research and their bioethical implications. In this way, it shows that placebo effects are evidence based, clinically relevant, and potentially ethical tools for relieving chronic pain.


Assuntos
Dor Crônica/tratamento farmacológico , Relações Médico-Paciente/ética , Placebos/efeitos adversos , Padrões de Prática Médica/ética , Teorema de Bayes , Dor Crônica/psicologia , Decepção , Método Duplo-Cego , Ética Médica , Humanos , Efeito Placebo , Placebos/administração & dosagem , Padrões de Prática Médica/estatística & dados numéricos
20.
Phys Ther ; 100(9): 1595-1602, 2020 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-32526017

RESUMO

OBJECTIVE: Although some studies have shown the clinical benefits of therapeutic exercise in chronic nonspecific low back pain, the effect sizes are generally small to moderate and recurrence rates are high. Transcranial direct current stimulation (tDCS) has been used to modulate pain-processing systems and motor outputs and has the potential to optimize the clinical benefits of therapeutic exercise. However, evidence for this combination is still lacking. The purpose of this protocol for a randomized clinical trial is to investigate whether the combination of tDCS and therapeutic exercise is more effective in relieving pain than therapeutic exercise alone. METHODS: This 2-arm, randomized controlled clinical trial will take place at the Federal University of Piauí, Brazil. Sixty patients will be randomized into 2 groups to receive tDCS (real/sham) + exercise therapies for 12 sessions over a period of 4 weeks. Pain intensity, sensory and affective aspects of pain, physical functioning, kinesiophobia, and global perceived effect will be recorded before treatment and at 4 weeks, 3 months, and 6 months after randomization. Data will be collected by an examiner unaware of (blind to) the treatment allocation. IMPACT: This trial can potentially provide important information and assist in clinical decision-making on the combined use of tDCS to optimize the clinical benefits of therapeutic exercise in patients with chronic nonspecific low back pain.


Assuntos
Dor Crônica/terapia , Terapia por Exercício/métodos , Dor Lombar/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Estimulação Transcraniana por Corrente Contínua/métodos , Brasil , Dor Crônica/psicologia , Terapia Combinada/métodos , Método Duplo-Cego , Terapia por Exercício/psicologia , Medo , Humanos , Dor Lombar/psicologia
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